Skip to main content
Erschienen in: Surgical Endoscopy 9/2017

30.12.2016

Respiratory dynamics and dead space to tidal volume ratio of volume-controlled versus pressure-controlled ventilation during prolonged gynecological laparoscopic surgery

verfasst von: Ming Lian, Xiao Zhao, Hong Wang, Lianhua Chen, Shitong Li

Erschienen in: Surgical Endoscopy | Ausgabe 9/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

Laparoscopic operations have become longer and more complex and applied to a broader patient population in the last decades. Prolonged gynecological laparoscopic surgeries require prolonged pneumoperitoneum and Trendelenburg position, which can influence respiratory dynamics and other measurements of pulmonary function. We investigated the differences between volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) and tried to determine the more efficient ventilation mode during prolonged pneumoperitoneum in gynecological laparoscopy.

Methods

Twenty-six patients scheduled for laparoscopic radical hysterectomy combined with or without laparoscopic pelvic lymphadenectomy were randomly allocated to be ventilated by either VCV or PCV. Standard anesthesic management and laparoscopic procedures were performed. Measurements of respiratory and hemodynamic dynamics were obtained after induction of anesthesia, at 10, 30, 60, and 120 min after establishing pneumoperitoneum, and at 10 min after return to supine lithotomy position and removal of carbon dioxide. The logistic regression model was applied to predict the corresponding critical value of duration of pneumoperitoneum when the Ppeak was higher than 40 cmH2O.

Results

Prolonged pneumoperitoneum and Trendelenburg position produced significant and clinically relevant changes in dynamic compliance and respiratory mechanics in anesthetized patients under PCV and VCV ventilation. Patients under PCV ventilation had a similar increase of dead space/tidal volume ratio, but had a lower Ppeak increase compared with those under VCV ventilation. The critical value of duration of pneumoperitoneum was predicted to be 355 min under VCV ventilation, corresponding to the risk of Ppeak higher than 40 cmH2O.

Conclusions

Both VCV and PCV can be safely applied to prolonged gynecological laparoscopic surgery. However, PCV may become the better choice of ventilation after ruling out of other reasons for Ppeak increasing.
Literatur
1.
Zurück zum Zitat Neira VM, Kovesi T, Guerra L et al (2015) The impact of pneumoperitoneum and Trendelenburg positioning on respiratory system mechanics during laparoscopic pelvic surgery in children: a prospective observational study. Can Anaesth Soc J 62(7):798–806CrossRef Neira VM, Kovesi T, Guerra L et al (2015) The impact of pneumoperitoneum and Trendelenburg positioning on respiratory system mechanics during laparoscopic pelvic surgery in children: a prospective observational study. Can Anaesth Soc J 62(7):798–806CrossRef
2.
Zurück zum Zitat Suh MK, Seong KW, Jung SH et al (2010) The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery. Korean J Anesthesiol 59(5):329–334CrossRefPubMedPubMedCentral Suh MK, Seong KW, Jung SH et al (2010) The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery. Korean J Anesthesiol 59(5):329–334CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Balick-Weber CC, Nicolas P, Hedreville-Montout M, Blanchet P, Stéphan F (2007) Respiratory and haemodynamic effects of volume-controlled vs pressure-controlled ventilation during laparoscopy: a cross-over study with echocardiographic assessment. Br J Anaesth 99:429–435CrossRefPubMed Balick-Weber CC, Nicolas P, Hedreville-Montout M, Blanchet P, Stéphan F (2007) Respiratory and haemodynamic effects of volume-controlled vs pressure-controlled ventilation during laparoscopy: a cross-over study with echocardiographic assessment. Br J Anaesth 99:429–435CrossRefPubMed
4.
Zurück zum Zitat Choi EM, Na S, Choi SH et al (2011) Comparison of volume-controlled and pressure-controlled ventilation in steep Trendelenburg position for robot-assisted laparoscopic radical prostatectomy. J Clin Anesth 23(3):183–188CrossRefPubMed Choi EM, Na S, Choi SH et al (2011) Comparison of volume-controlled and pressure-controlled ventilation in steep Trendelenburg position for robot-assisted laparoscopic radical prostatectomy. J Clin Anesth 23(3):183–188CrossRefPubMed
5.
Zurück zum Zitat Campbell RS, Davis BR (2002) Pressure-controlled versus volume-controlled ventilation: does it matter? Respir Care 47:416–424PubMed Campbell RS, Davis BR (2002) Pressure-controlled versus volume-controlled ventilation: does it matter? Respir Care 47:416–424PubMed
6.
Zurück zum Zitat Fahy BG, Barnas GM, Nagle SE et al (1996) Effects of Trendelenburg and reverse Trendelenburg postures on lung and chest wall mechanics. J Clin Anesth 8:236–244CrossRefPubMed Fahy BG, Barnas GM, Nagle SE et al (1996) Effects of Trendelenburg and reverse Trendelenburg postures on lung and chest wall mechanics. J Clin Anesth 8:236–244CrossRefPubMed
7.
Zurück zum Zitat Tweed WA, Phua WT, Chong KY et al (1991) Large tidal volume ventilation improves pulmonary gas exchange during lower abdominal surgery in Trendelenburg’s position. Can J Anaesth 38:989–995CrossRefPubMed Tweed WA, Phua WT, Chong KY et al (1991) Large tidal volume ventilation improves pulmonary gas exchange during lower abdominal surgery in Trendelenburg’s position. Can J Anaesth 38:989–995CrossRefPubMed
8.
Zurück zum Zitat Takahata O, Kunisawa T, Nagashima M et al (2007) Effect of age on pulmonary gas exchange during laparoscopy in the Trendelenburg lithotomy position. Acta Anaesthesiol Scand 51(6):687–692CrossRefPubMed Takahata O, Kunisawa T, Nagashima M et al (2007) Effect of age on pulmonary gas exchange during laparoscopy in the Trendelenburg lithotomy position. Acta Anaesthesiol Scand 51(6):687–692CrossRefPubMed
9.
Zurück zum Zitat Nguyen NT, Anderson JT, Budd M et al (2004) Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass. Surg Endosc 18(1):64–71CrossRefPubMed Nguyen NT, Anderson JT, Budd M et al (2004) Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass. Surg Endosc 18(1):64–71CrossRefPubMed
10.
Zurück zum Zitat Hardman JG, Aitkenhead AR (2003) Estimating alveolar dead space from the arterial to end-tidal CO2 gradient: a modeling analysis. Anesth Analg 97:1846–1851CrossRefPubMed Hardman JG, Aitkenhead AR (2003) Estimating alveolar dead space from the arterial to end-tidal CO2 gradient: a modeling analysis. Anesth Analg 97:1846–1851CrossRefPubMed
11.
Zurück zum Zitat Cadi P, Guenoun T, Journois D, Chevallier JM, Diehl JL, Safran D (2008) Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume-controlled ventilation. Br J Anaesth 100:709–716CrossRefPubMed Cadi P, Guenoun T, Journois D, Chevallier JM, Diehl JL, Safran D (2008) Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume-controlled ventilation. Br J Anaesth 100:709–716CrossRefPubMed
12.
Zurück zum Zitat De Baerdemaeker LE, Van der HC, Gillardin JM et al (2008) Comparison of volume-controlled and pressure-controlled ventilation during laparoscopic gastric banding in morbidly obese patients. Obes Surg 18:680–685CrossRefPubMed De Baerdemaeker LE, Van der HC, Gillardin JM et al (2008) Comparison of volume-controlled and pressure-controlled ventilation during laparoscopic gastric banding in morbidly obese patients. Obes Surg 18:680–685CrossRefPubMed
13.
Zurück zum Zitat Sun MTA, Shi CL (2002) Recent advances in the clinical application of heart-lung interactions. Curr Opin Crit Care 8(1):26–31CrossRef Sun MTA, Shi CL (2002) Recent advances in the clinical application of heart-lung interactions. Curr Opin Crit Care 8(1):26–31CrossRef
14.
Zurück zum Zitat Sizlan A, Karaşahin E, Coşar A et al (2010) Pressure-Controlled vs Volume-Controlled Ventilation During Laparoscopic Gynecological Surgery. J Minim Invasive Gynecol 17(3):295–300CrossRefPubMed Sizlan A, Karaşahin E, Coşar A et al (2010) Pressure-Controlled vs Volume-Controlled Ventilation During Laparoscopic Gynecological Surgery. J Minim Invasive Gynecol 17(3):295–300CrossRefPubMed
15.
Zurück zum Zitat Salihoglu Z, Demiroluk S, Cakmakkaya S, Gorgun E, Kose Y (2002) Influence of the patient positioning on respiratory mechanics during pneumoperitoneum. Middle East J Anesthesiol 16:521–528PubMed Salihoglu Z, Demiroluk S, Cakmakkaya S, Gorgun E, Kose Y (2002) Influence of the patient positioning on respiratory mechanics during pneumoperitoneum. Middle East J Anesthesiol 16:521–528PubMed
16.
Zurück zum Zitat Mäkinen MT, Yli-Hankala A (1996) The effect of laparoscopic cholecystectomy on respiratory compliance as determined by continuous spirometry. J Clin Anesth 8:119–122CrossRefPubMed Mäkinen MT, Yli-Hankala A (1996) The effect of laparoscopic cholecystectomy on respiratory compliance as determined by continuous spirometry. J Clin Anesth 8:119–122CrossRefPubMed
17.
Zurück zum Zitat Bardoczky GI, Engelman E, Levarlet M et al (1993) Ventilatory effects of pneumoperitoneum monitored with continuous spirometry. Anaesthesia 48(4):309–311CrossRefPubMed Bardoczky GI, Engelman E, Levarlet M et al (1993) Ventilatory effects of pneumoperitoneum monitored with continuous spirometry. Anaesthesia 48(4):309–311CrossRefPubMed
18.
Zurück zum Zitat Nyarwaya JB, Mazoit JX, Samii K (1994) Are pulse oximetry and end-tidal carbon dioxide tension monitoring reliable during laparoscopic surgery? Anaesthesia 49:775–778CrossRefPubMed Nyarwaya JB, Mazoit JX, Samii K (1994) Are pulse oximetry and end-tidal carbon dioxide tension monitoring reliable during laparoscopic surgery? Anaesthesia 49:775–778CrossRefPubMed
19.
Zurück zum Zitat Yamanaka MK, Sue DY (1987) Comparison of arterial-end-tidal PCO2 difference and dead space/tidal volume ratio in respiratory failure. Chest 92:832–835CrossRefPubMed Yamanaka MK, Sue DY (1987) Comparison of arterial-end-tidal PCO2 difference and dead space/tidal volume ratio in respiratory failure. Chest 92:832–835CrossRefPubMed
20.
Zurück zum Zitat Subrata S, Donn SM (2007) In support of pressure support. Clin Perinatol 34(1):117–128CrossRef Subrata S, Donn SM (2007) In support of pressure support. Clin Perinatol 34(1):117–128CrossRef
21.
Zurück zum Zitat Meininger D, Zwissler B, Byhahn C, Probst M, Westphal K, Bremerich DH (2006) Impact of overweight and pneumoperitoneum on hemodynamics and oxygenation during prolonged laparoscopic surgery. World J Surg 30:520–526CrossRefPubMed Meininger D, Zwissler B, Byhahn C, Probst M, Westphal K, Bremerich DH (2006) Impact of overweight and pneumoperitoneum on hemodynamics and oxygenation during prolonged laparoscopic surgery. World J Surg 30:520–526CrossRefPubMed
22.
Zurück zum Zitat Dreyfuss D, Saumon G (2014) Ventilator-induced Lung Injury. N Engl J Med 370(10):979–980CrossRef Dreyfuss D, Saumon G (2014) Ventilator-induced Lung Injury. N Engl J Med 370(10):979–980CrossRef
Metadaten
Titel
Respiratory dynamics and dead space to tidal volume ratio of volume-controlled versus pressure-controlled ventilation during prolonged gynecological laparoscopic surgery
verfasst von
Ming Lian
Xiao Zhao
Hong Wang
Lianhua Chen
Shitong Li
Publikationsdatum
30.12.2016
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 9/2017
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5392-x

Weitere Artikel der Ausgabe 9/2017

Surgical Endoscopy 9/2017 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.